Evaluation of clinical and antidiabetic treatment characteristics of different sub-groups of patients with type 2 diabetes: Data from a Mediterranean population database

Abstract

Aims: To describe the characteristics and antidiabetic treatment among type 2 diabetes patients according to the clinical conditions prioritized in the Spanish 2020 RedGDPS (Primary Care Diabetes Study Groups Network) therapeutic algorithm: obesity, older than 75 years, chronic kidney disease, cardiovascular disease, and heart failure. Methods: Retrospective, cross-sectional study. Clinical characteristics, the use of antidiabetic drugs and the KDIGO renal risk categories at 31.12.2016 were retrieved from the SIDIAP (Information System for Research in Primary Care) database (Catalonia, Spain). Results: From a total of 373,185 type 2 diabetes patients, 37% were older than 75 years, 45% obese, 33% had chronic kidney disease, 23.2% cardiovascular disease and 6.9% heart failure. Insulin was more frequently prescribed in chronic kidney disease, cardiovascular disease and heart failure whereas Sodium-Glucose cotransporter 2 inhibitors and Glucagon Like Peptide 1 receptor agonists were scarcely prescribed (2.6% and 1.4%, respectively). Among patients with severe renal failure, contraindicated drugs like metformin (16%) and sulfonylureas (6.1%) were still in use. The 2012 KDIGO renal risk categories distribution was: Low: 60.9%, Moderate: 21.6%, High: 9.8% and Very high: 7.7%. Conclusions: Almost 80% of our T2DM patients meet one of the five clinical conditions that should be considered for treatment individualization. Importantly, a relevant number of patients with severe renal failure were found to use contraindicated drugs.

Trends in the Degree of Control and Treatment of Cardiovascular Risk Factors in People With Type 2 Diabetes in a Primary Care Setting in Catalonia During 2007–2018

“…The antidiabetic treatment is free of charge for retired and severely ill people, while active subjects pay just a small part of the cost of the drugs. Since 2006, a system of electronic medical records (EMR), called e-CAP, was fully implemented in primary care, which allowed the creation of the SIDIAP population database ( 19 , 20 ). To date, it is not known whether there has been progress in the degree of control of the three primary objectives (HbA1c, BP, and LDL-C) in our primary care environment.…”

Beyond the Glycaemic Control of Dapagliflozin: Impact on Arterial Stiffness and Macroangiopathy

“…The evidence shown in this review suggests that the use of dapagliflozin is associated with numerous clinical benefits beyond glycaemic control, facilitating the control of CV risk factors and decreasing the incidence of CV events. However, SGLT2i are a family of drugs that are underutilised in actual clinical practice in patients with T2DM [ 9 – 12 , 70 ]. In the context of cardiology, there is also a risk of underuse of dapagliflozin for the treatment of HFrEF [ 71 ].…”

Sodium‐glucose co‐transporter‐2 inhibitors in patients with type 2 diabetes: Barriers and solutions for improving uptake in routine clinical practice

“…The safety profile of SGLT‐2 inhibitors is nevertheless well established 50 and many studies report benefits beyond glycaemic control, including cardiovascular and kidney protection 11,38,51 . Despite these benefits, therapeutic inertia among clinicians may play a role in the lack of uptake of this class of drugs, with many clinicians continuing to focus on glycaemic control as the primary outcome in the treatment of T2D 21,52 . There may be potential interventions to overcome therapeutic inertia 53,54 (Figure 4).…”